36
BPCI-Advanced
• CMS released on January 9
th
, 2018
• Voluntary model
• 29 inpatient and 3 outpatient clinical
episodes
• CJR takes precedence
• Hierarchy: Attending, Operating,
then Hospital
• Effective Oct 1, 2018 through
December 31, 2023
• 90 day post discharge episodes
(like CJR)
• 20% stop loss/stop gain out the gate
(not like CJR)
• Quality metrics
• All-cause Hospital Readmission
Measure (NQF #1789)
• Advanced Care Plan (NQF #0326)
• Perioperative Care: Selection of
Prophylactic Antibiotic: First or Second
Generation Cephalosporin
(NQF #0268)
• Hospital-Level Risk-Standardized
Complication Rate (RSCR) Following
Elective Primary Total Hip Arthroplasty
(THA) and/or Total Knee Arthroplasty
(TKA) (NQF #1550)
• Hospital 30-Day, All-Cause, Risk-
Standardized Mortality Rate (RSMR)
Following Coronary Artery Bypass
Graft Surgery (NQF #2558)
• Excess Days in Acute Care after
Hospitalization for Acute Myocardial
Infraction (NQF #2881)
• ARRQ Patient Safety Indicators
(PSI 90)